Differences In Allostatic Load Research Articles

ALLOSTATIC LOAD AND STATUS IN MID LIFE AND BEYOND

Abstract Objective This study explores how status and processes of cumulative dis/advantage shape allostatic load across the life course. Methods Data from these analyses are from a national sample of adults from the Biomarker Substudy of the Study of Midlife in the US (MIDUS), a longitudinal study of health and well-being in the United States (N=1186) aged 35-86 years old. Education level, multiple indicators of financial stability, and demographic data were used to construct a measure of status. Those in the Biomarker substudy completed a physiological assessment that included blood, urine, and saliva assays to assess functioning of the sympathetic and parasympathetic nervous systems, hypothalamic-pituitary-adrenal axis, cardiovascular, inflammatory immune activity, glucose metabolic system, and lipid metabolic system. These data were used to create an allostatic load index. An alternate allostatic load index was developed using reported medication to affect three of seven biological systems: cardiovascular and the glucose and lipid metabolic systems. Nested regression models were estimated to explain differences in allostatic load. Results Reported financial instability across the life course was associated with higher levels of allostatic load, and higher levels of education were associated with lower levels of allostatic load, both with and without reported medication usage. Conclusion These findings demonstrate that structural forces impact allostatic load, both with and without reported medication usage, and expand previous work on allostatic load and social status.

Age differences in Allostatic Load among adults in the United States by rural-urban residence

•Rural residence is associated with allostatic load levels by age groups.•Allostatic load is higher among rural adults with the exception of the oldest age group.•Evidence of a rural-urban convergence in allostatic load levels among oldest old.•These rural disadvantages remained strong even when accounting for covariates.•The study of allostatic load can improve our understanding of rural disparities.

Investigating Racial Differences in Allostatic Load by Educational Attainment among Non-Hispanic Black and White Men.

Education continues to be a key factor contributing to increased access to critical life-improving opportunities and has been found to be protective against Allostatic Load (AL). The purpose of this study was to assess AL among Non-Hispanic (NH) White and NH Black men with the same level of education. We used 1999–2016 National Health and Nutrition Examination Surveys (NHANES) data with an analytical sample of 6472 men (1842 NH Black and 4630 NH White), and nine biomarkers to measure AL, controlling for various demographic and health-related factors. NH Black men had a higher AL score than NH White men (39.1%, 842 vs. 37.7%, 1,975). Racial disparities in AL between NH Black and NH White men who have a college degree or above (PR: 1.49, CI: [1.24–1.80]) were observed. Models posited similar AL differences at every other level of education, although these were not statistically significant. The findings reveal that socioeconomic returns to education and the societal protective mechanisms associated with education vary greatly between White and Black men.

Investigation of Differences in Allostatic Load among Black Men by Level of Educational Attainment: High School Graduates Experience the Highest Levels of Stress.

Allostatic load (AL)—the biological assessment of long-term exposure to stress—may explain mortality-rate disparities among non-Hispanic Black (Black) men. We aimed to investigate AL among Black men with equivalent education status after controlling for income. A cross-sectional study was employed to investigate AL among 4113 Black men who participated in the National Health and Nutrition Examination Survey between 1999–2018. A summation of 8 biomarker factors were used to compute AL, differences in socio-demographic characteristics by education status were evaluated, and health behaviors that may influence AL were examined. To determine the high-risk thresholds for each AL component, we examined each component’s distribution among NHB men for whom complete biomarker data were available in the NHANES sample. High-risk thresholds were determined as either (1) above the 75th percentile for body mass index (BMI), diastolic blood pressure (DBP), glycated hemoglobin, systolic blood pressure (SBP), total cholesterol, and serum triglycerides; or (2) below the 25th percentile for serum albumin and serum creatinine. Modified Poisson regression models were used to estimate prevalence ratios and their associated 95% confidence intervals for high AL risk while adjusting for potential confounders. Black men with a high school diploma/GED had a greater prevalence of high AL compared with Black men who had other levels of education, and a slightly higher prevalence of high AL compared with Black men who had less than a high school education. Black men with college degrees had a lower prevalence of high AL than Black men with the lowest levels of educational attainment. Researchers must further examine the hidden costs stemming from the interplay between discrimination associated with being Black in America and systemic racism in the educational system—which may be preventing Black men from achieving optimal health.

Race Differences in Allostatic Load Among Black and White Men: Does Age Matter?

Although Black-White disparities in health and mortality among men persist, there has been a paucity of work focusing on race differences in physiological dysregulation of biological processes resulting from the cumulative impact of stressors among men. The purpose of this study was to assess potential race differences in Allostatic Load (AL) among adult men and if such differences varied by age. Data were drawn from the 1999-2016 NHANES and the study population included 21,529 non-Hispanic Black (NHB) and 34,282 Non-Hispanic White (NHW) born in US. Adjusting for potential confounders, NHB men 25-44 and 45-64 had a higher AL score (OR = 1.19, 95% confidence interval (CI) 1.00, 1.42) and (OR = 1.14, 95% confidence interval (CI) 1.02, 1.28) NHW men. No race differences with respect to AL score were observed among the other age groups. The results suggest that age plays a role in race differences in AL

Social Determinants of Men’s Health Across the Life Course

There is a paucity of research focusing on the complex interaction between social, behavioral, biological, and psychosocial factors, and health outcomes among men. This symposium contains a collection of papers that discuss some key social determinants of health (SDOH) that can provide insights to advance our understanding of men’s health and aging across the life course. Dawn will discuss the Stroke Counseling for Risk Reduction (SCORRE) intervention designed to increase awareness, risk perceptions, and health behaviors to reduce stroke risk in African Americans. Findings suggest tailoring the intervention to the needs and preferences of young African American men. Archibald and colleagues seek to determine if race differences in allostatic load (AL) among adult men vary by age. Black men 45-64 had a higher AL score (PR = 1.14, 95% CI 1.02, 1.28) than White men. Skipper and colleagues used a grounded theory approach to examine the negative interactions of 35 religious middle and old age Black men. Analyses reveal that church-related negative interactions broadly fall within the following themes: (1) ageism within intergenerational churches, (2) people are messy, and (3) issues with leadership. Bruce and colleagues examine the association between religious service attendance and mortality among Black men. Participants who attended at least once per week were 18% less likely to die than their peers who did not attend a religious service at all (HR 0.82; 95% CI 0.68-0.99). These presentations collectively will bolster our knowledge on key SDOH among men across the life course.

Age differences in allostatic load among veterans: The importance of combat exposure.

The current study examinedage differences in allostatic load among nonveterans, noncombat veterans, and combat veterans. Participants included 280 individuals from the Midlife Development in the United States (MIDUS) survey, including 164 veterans (n=48 combat veterans; n=116 noncombat veterans) and 116 nonveterans. Age differences in allostatic load were similar among nonveterans and noncombat veterans, B=0.002, SE=.011, p=.878, with older adults showing higher levels of allostatic load than their comparatively younger counterparts. Among combat veterans, however, a different pattern emerged. In this group, levels of allostatic load were similar across age, seemingly due to higher levels of allostatic load among younger combat veterans, B=-0.029, SE=.014, p=.031, ƞp 2 = .022. Results reveal the importance of considering combat exposure when examining health outcomes of military veterans, particularly in the context of age.

Allostatic Load Among Black Sexual Minority Women.

Background: Allostatic load is the physiological deterioration that accumulates as the body responds to stress, resulting in disparities in chronic disease. Although perceptions of stress vary, marginalization and social disadvantage are associated with elevated allostatic load. Allostatic load is understudied in the multiply marginalized populations of sexual minority Black women. Methods: We used data from six waves of the National Health and Nutrition Examination Survey (2001-2010, 2015-2016) to identify heterosexual (n = 78), lesbian (n = 21), and bisexual (n = 57) Black women. We quantified allostatic load using nine biomarkers, and compared mean allostatic load across the three groups, adjusting for age, educational attainment, income, and country of birth to account for possible confounding. Results: We found no significant differences in allostatic load among heterosexual, lesbian, and bisexual Black women. Conclusions: These findings suggest that sexual orientation may not contribute to within-group differences in allostatic load among Black women, a group previously noted to have elevated allostatic load.

Social status differences in allostatic load among young adults in the United States

Allostatic load refers to wear and tear on the body due to repeated activation of the stress response and, thus, may be an early subclinical indicator of future disease and mortality risk. To date, few studies of allostatic load have focused on young adults, racial/ethnic comparisons that include Mexican Americans, or the interplay between race/ethnicity, gender, and educational attainment. To fill these gaps, we used data on non-Hispanic Black, non-Hispanic White, and Mexican-origin respondents from Waves I (1994–1995) and IV (2007–2008) of the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 11,807). We calculated allostatic load scores based on respondents’ values for 10 metabolic, cardiovascular, and inflammatory biomarkers measured at Wave IV, when respondents were 24–34 years old. We then used negative binomial regression models to assess the combined effects of race/ethnicity, gender, and educational attainment on allostatic load, while controlling for key covariates. We found that Black women had significantly higher allostatic load scores than White women and Black men, net of educational attainment and other covariates. Yet, education modified the relationship between race/ethnicity, gender, and allostatic load. Obtaining a college education was protective for White males and females but no more or less protective for other women and deleterious for Black males. In other words, by the time they reach young adulthood, the cumulative physiological burden of stress on Black women and college-educated Black men is already greater than it is among their similarly or less educated White counterparts. These findings provide important information about the intermediate physiological dysregulation that underlies social inequalities in stress-related health outcomes, especially those that occur at the intersections of race/ethnicity, gender, and educational attainment. They also suggest that research on its antecedents should focus on earlier life periods.

RACE DIFFERENCES IN ALLOSTATIC LOAD AMONG BLACK AND WHITE MEN: DOES AGE MATTER?

Although Black-White disparities in health and mortality among men persist, there is a paucity of work focusing on race differences in physiological dysregulation of biological processes resulting from the cumulative impact of stressors among men. The purpose of this study was to assess potential race differences in Allostatic Load (AL) among adult men and if such differences vary by age. Data were drawn from the 1999-2010 NHANES, and the study population included 2700 non-Hispanic Black (NHB) and 19930 Non-Hispanic White (NHW) born in US. AL was derived by summing across cardiovascular, metabolic, and inflammatory biomarkers considered to be high risk, resulting in a count variable ranging from 0 to 9. Race was based on self-report. Age was categorized: 18-24, 25-44, 45-64, and 65 years and older. Negative binomial regression was used to examine the relationship between race and AL score. Models included education, marital status, family income, health insurance and self-reported health. Adjusting for potential confounders, NHB men had a higher AL score ((incidence rate ratio (IRR) = 1.06, 95% confidence interval (CI) 1.01, 1.11) than NHW men. NHB men 25-44 years old had a higher AL score than (IRR = 1.14, 95% CI;1.04, 1.24) than their NHW peers. No race differences with respect to AL score were observed among the other age groups. Race differences in AL vary by age categories. Efforts to improve longevity should focus on developing age-tailored health promoting strategies to reduce stress among Black men during early adulthood.

Does marriage matter? Racial differences in allostatic load among women.

Prior research suggests that there are health benefits associated with marriage, although the physiological implications of marital status for women's health is less clear. Given that recent trends indicate that Black women are less likely to marry than White women, the goal of this study was to evaluate whether marital status accounts for racial differences in women's physical health. Using data from the Nashville Stress and Health Study (2011–2014), we estimated the probability of high allostatic load (AL), a biological indicator of physiological dysregulation, among women aged 18–69. We examined AL scores by race and marital status, evaluated the extent to which Black-White differences persisted after accounting for marital status, and assessed whether the racial disparity in AL varied across marital status groups. Results indicated that Black women had higher AL than White women, although racial differences in AL were not explained by marital status. In addition, marital status was a significant predictor of AL among Black, but not White women. Moreover, the racial disparity in AL was smallest among never married women and largest among currently and formally married women. Taken together, these findings suggest that Black-White inequalities in women's physical health are not explained by racial differences in marital status, despite the widening racial gap in marriage. Nevertheless, marital status may be an influential factor in shaping outcomes among Black women.

Consumption of fast food, sugar-sweetened beverages, artificially-sweetened beverages and allostatic load among young adults.

This study investigates the associations between recent consumption of fast foods, sugar-sweetened beverages, and artificially-sweetened beverages on level of allostatic load, a measure of cumulative biological risk, in young adults in the US. Data from Wave IV of the National Longitudinal Study of Adolescent to Adult Health were analyzed. Negative binomial regression models were used to estimate the associations between consumption of fast foods, sugar-sweetened, and artificially-sweetened beverages and allostatic load. Poisson and logistic regression models were used to estimate the associations between these diet parameters and combined biomarkers of physiological subsystems that comprise our measure of allostatic load. All analyses were weighted and findings are representative of young adults in the US, ages 24–34 in 2008 (n = 11,562). Consumption of fast foods, sugar-sweetened, and artificially-sweetened beverages were associated with higher allostatic load at a bivariate level. Accounting for demographics and medication use, only artificially-sweetened beverages remained significantly associated with allostatic load. When all three dietary components were simultaneously included in a model, both sugar- and artificially-sweetened beverage consumption were associated with higher allostatic load. Differences in allostatic load emerge early in the life course and young adults consuming sugar- or artificially-sweetened beverages have higher allostatic load, net of demographics and medication use. Public health messages to young adults may need to include cautions about both sugar- and artificially-sweetened beverages.

Self-identified race, socially assigned skin tone, and adult physiological dysregulation: Assessing multiple dimensions of “race” in health disparities research

Despite a general acceptance of “race” as a social, rather than biological construct in the social sciences, racial health disparities research has given less consideration to the dimensions of race that may be most important for shaping persistent disparities in adult physical health status. In this study, we incorporate the social constructionist view that race is multidimensional to evaluate the health significance of two measures of race, racial self-identification and the socially perceived skin tone of black Americans, in a sample of black and white adults in the Nashville Stress and Health Study (N=1186). First, we use the approach most common in disparities research—comparing group differences in an outcome—to consider self-identified racial differences in allostatic load (AL), a cumulative biological indicator of physical dysregulation. Second, we examine intragroup variations in AL among blacks by skin tone (i.e. light, brown, or dark skin). Third, we assess whether the magnitude of black-white disparities are equal across black skin tone subgroups. Consistent with prior research, we find significantly higher rates of dysregulation among blacks. However, our results also show that racial differences in AL vary by blacks’ skin tone; AL disparities are largest between whites and dark-skinned blacks and smallest between whites and light-skinned blacks. This study highlights the importance of blacks’ skin tone as a marker of socially-assigned race for shaping intragroup and intergroup variations in adult physiological dysregulation. These results demonstrate the importance of assessing multiple dimensions of race in disparities research, as this approach may better capture the various mechanisms by which “race” continues to shape health.

Nativity differences in allostatic load by age, sex, and Hispanic background from the Hispanic Community Health Study/Study of Latinos

Allostatic load (AL), an index of biological “wear and tear” on the body from cumulative exposure to stress, has been little studied in US Hispanics/Latinos. We investigated AL accumulation patterns by age, sex, and nativity in the Hispanic Community Health Study/Study of Latinos. We studied 15,830 Hispanic/Latinos of Mexican, Cuban, Dominican, Puerto Rican, Central and South American descent aged 18–74 years, 77% of whom were foreign-born. Consistent with the conceptualization of AL, we developed an index based upon 16 physiological markers that spanned the cardiometabolic, parasympathetic, and inflammatory systems. We computed mean adjusted AL scores using log-linear models across age-groups (18–44, 45–54, 55–74 years), by sex and nativity status. Among foreign-born individuals, differences in AL by duration of residence in the US (<10, ≥10 years) and age at migration (<24, ≥24 years) were also examined. In persons younger than 55 years old, after controlling for socioeconomic and behavioral factors, AL was highest among US-born individuals, intermediate in foreign-born Hispanics/Latinos with longer duration in the US (≥10 years), and lowest among those with shorter duration in the US (<10 years) (P<0.0001 for increasing trend). Similarly, AL increased among the foreign-born with earlier age at immigration. These trends were less pronounced among individuals ≥55 years of age. Similar patterns were observed across all Hispanic/Latino heritage groups (P for interaction=0.5). Our findings support both a “healthy immigrant” pattern and a loss of health advantage over time among US Hispanics/Latinos of diverse heritages.

Allostatic load in foreign-born and US-born blacks: evidence from the 2001-2010 National Health and Nutrition Examination Survey.

We tested whether the immigrant health advantage applies to non-Hispanic Black immigrants and examined whether nativity-based differences in allostatic load exist among non-Hispanic Blacks. We used pooled data from the 2001-2010 National Health and Nutrition Examination Survey to compare allostatic load scores for US-born (n = 2745) and foreign-born (n = 152) Black adults. We used multivariate logistic regression techniques to assess the association between nativity and high allostatic load scores, controlling for gender, age, health behaviors, and socioeconomic status. For foreign-born Blacks, length of stay and age were powerful predictors of allostatic load scores. For older US-born Blacks and those who were widowed, divorced, or separated, the risk of high allostatic load was greater. Foreign-born Blacks have a health advantage in allostatic load. Further research is needed that underscores a deeper understanding of the mechanisms driving this health differential to create programs that target these populations differently.

The Role of Education in Explaining Racial/Ethnic Allostatic Load Differentials in the United States

This study expands on earlier findings of racial/ethnic and education–allostatic load associations by assessing whether racial/ethnic differences in allostatic load persist across all levels of educational attainment. This study used data from four recent waves of the National Health and Nutrition Survey (NHANES). Results from this study suggest that allostatic load differs significantly by race/ethnicity and educational attainment overall, but that the race/ethnicity association is not consistent across education level. Analysis of interactions and education-stratified models suggest that allostatic load levels do not differ by race/ethnicity for individuals with low education; rather, the largest allostatic load differentials for Mexican Americans (p < .01) and non-Hispanic blacks (p < .001) are observed for individuals with a college degree or more. These findings add to the growing evidence that differences in socioeconomic opportunities by race/ethnicity are likely a consequence of differential returns to education, which contribute to higher stress burdens among minorities compared to non-Hispanic whites.

Allostatic load and birth outcomes among white and black women in New Orleans.

As a marker of chronic stress, allostatic load has been theoretically recognized as a potential contributor to racial disparities in birth outcomes. The purpose of this investigation was to identify associations between allostatic load and birth outcomes and to assess differences in allostatic load and its relation to birth outcomes between white and black women. Blood samples from 123 women at 26-28 weeks gestation were assayed for cholesterol, glycosylated hemoglobin, dehydroepiandrosterone-sulfate, and cortisol, with 42 women having complete data on all biomarkers and birth outcomes. Together with systolic blood pressure, these biomarkers were combined to create an allostatic load index. Multiple linear regression models were used to evaluate associations between allostatic load index and gestational age, birth weight, birth weight ratio, birth length, and head circumference. Black women had a significantly lower allostatic load index than white women (P < 0.05). Gestational age was the only outcome significantly associated with allostatic load in both unadjusted and adjusted models (P < 0.05). Gestational age decreased significantly with increasing allostatic load (adjusted β -0.18, 95 % CI -0.35, 0.00). A significant interaction with age indicated that the effect was less strong at higher maternal ages (adjusted interaction β 0.04, 95 % CI 0.00, 0.08). There was no racial difference in the effect of allostatic load on birth outcomes. These findings represent possible evidence of the effect of stress age on gestational age. As a measure of cumulative disadvantage, allostatic load may prove to be a contributor to the racial disparities in birth outcomes.

Allostatic Load Among Non-Hispanic Whites, Non-Hispanic Blacks, and People of Mexican Origin: Effects of Ethnicity, Nativity, and Acculturation

We investigated ethnic differences in allostatic load in a population-based sample of adults living in Texas City, TX, and assessed the effects of nativity and acculturation status on allostatic load among people of Mexican origin. We used logistic regression models to examine ethnic variations in allostatic load scores among non-Hispanic Whites, non-Hispanic Blacks, and people of Mexican origin. We also examined associations between measures of acculturation and allostatic load scores among people of Mexican origin only. Foreign-born Mexicans were the least likely group to score in the higher allostatic load categories. Among individuals of Mexican origin, US-born Mexican Americans had higher allostatic load scores than foreign-born Mexicans, and acculturation measures did not account for the difference. Our findings expand on recent research from the National Health and Nutrition Examination Survey with respect to ethnicity and allostatic load. Our results are consistent with the healthy immigrant hypothesis (i.e., newer immigrants are healthier) and the acculturation hypothesis, according to which the longer Mexican immigrants reside in the United States, the greater their likelihood of potentially losing culture-related health-protective effects.

Is burnout related to allostatic load?

Burnout has a negative impact on physical health, but the mechanisms underlying this relation remain unclear. To elucidate these mechanisms, possible mediating physiological systems or risk factors for adverse health in burned-out employees should be investigated. The aim of the present study among 290 Dutch managers was to explore whether allostatic load mediates the relationship between burnout and physical health. Burned-out managers, as identified with the Maslach Burnout Inventory General Survey (MBI-GS), were compared with a healthy control group with regard to their allostatic load. The allostatic load index included eight parameters: Body-mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), C-reactive protein (CRP), high-density lipoprotein (HDL), cholesterol, glycosylated hemoglobin (HbA1C) and glucose. Contrary to expectations, burned-out managers did not differ from healthy managers with regard to their scores on the allostatic load index. An additional analysis, using groups of managers in the extreme deciles of exhaustion (the core symptom of burnout), did also not reveal differences in allostatic load. Burnout seems not to be associated with this proxy measure of allostatic load. The mediating physiological mechanisms between burnout and objective physical health remain to be elucidated.

Allostatic Load: A Mechanism of Socioeconomic Health Disparities?

Although research on health disparities has been prioritized by the National Institutes of Health, the Institute of Medicine, and Healthy People 2010, little has been published that examines the biology underlying health disparities. Allostatic load is a multisystem construct theorized to quantify stress-induced biological risk. Differences in allostatic load may reflect differences in stress exposure and thus provide a mechanistic link to understanding health disparities. The purpose of this systematic review is to examine the construct of allostatic load and the published studies that employ it in an effort to understand whether the construct can be useful in quantifying health disparities. The published literature demonstrates that allostatic load is elevated in those of low socioeconomic status (SES) as compared to those of high SES. The reviewed articles vary in the justification for inclusion of variables. Recommendations for future research are made in the contexts of measurement, methodology, and racial composition of participants.